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Werner NE, Morgen M, Kooiman S, Jolliff A, Warner G, Feinstein J, Chui M, Katz B, Storhoff B, Sodergren K, Coller R. Effectiveness of a Mobile App (Meds@HOME) to Improve Medication Safety for Children With Medical Complexity: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e60621. [PMID: 39250787 PMCID: PMC11420605 DOI: 10.2196/60621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND This study will pilot-test the mobile app, Medication Safety @HOME-Meds@HOME intervention to improve medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management for children with medical complexity (CMC). The Meds@HOME app was co-designed with CMC families, secondary caregivers (SCGs), and health professionals to support medication management for primary caregivers (PCGs) and SCGs of CMC. We hypothesize that Meds@HOME will improve caregivers' medication administration accuracy, reduce preventable adverse drug events, and ultimately improve chronic care management. OBJECTIVE This study aims to evaluate the effectiveness of Meds@HOME on medication administration accuracy for PCGs and SCGs. METHODS This study will recruit up to 152 PCGs and 304 SCGs of CMC who are prescribed at least 1 scheduled high-risk medication and receive care at the University of Wisconsin American Family Children's Hospital. PCGs will be randomly assigned, for the 6-month trial, to either the control group (not trialing Meds@HOME) or the intervention group (trialing Meds@HOME) using 1:1 ratio. The Meds@HOME app allows caregivers to create a child profile, store medication and care instructions, and receive reminders for upcoming and overdue care routines and medication refills. Surveys completed both at the start and end of the trial measure demographics, medication delivery knowledge, confidence in the CMC's caregiving network, and comfort with medical information. Univariate and multivariate generalized estimation equations will be used for primary statistical analysis. The primary outcome is the PCG's rate of medication administration accuracy measured as correct identification of each of the following for a randomly selected high-risk medication: indication, formulation, dose, frequency, and route at baseline and after 6 months. Secondary outcomes include SCG medication administration accuracy (indication, formulation, dose, frequency, and route), count of University of Wisconsin hospital and emergency department encounters, PCG-reported medication adherence, count of deaths, and PCG medication confidence and understanding. RESULTS Recruitment for this study began on November 29, 2023. As of May 15, 2024, we have enrolled 94/152 (62%) PCGs. We expect recruitment to end by August 1, 2024, and the final participant will complete the study by January 28, 2025, at which point we will start analyzing the complete responses. We expect publication of results at the end of 2025. CONCLUSIONS The Meds@HOME mobile app provides a promising strategy for improving PCG medication safety for CMC who take high-risk medications. In addition, this protocol highlights novel procedures for recruiting SCGs of CMC. In the future, this app could be used more broadly across diverse caregiving networks to navigate complex medication routines and promote medication safety. TRIAL REGISTRATION ClinicalTrials.gov NCT05816590; https://clinicaltrials.gov/study/NCT05816590. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/60621.
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Affiliation(s)
- Nicole E Werner
- Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Makenzie Morgen
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Sophie Kooiman
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Anna Jolliff
- Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
| | - Gemma Warner
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - James Feinstein
- University of Colorado School of Medicine, Aurora, CO, United States
| | - Michelle Chui
- University of Wisconsin-Madison School of Pharmacy, Madison, WI, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, WI, United States
| | - Brittany Storhoff
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Kristan Sodergren
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Ryan Coller
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
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Sabblah GT, van Hunsel F, Taxis K, Duwiejua M, Seaneke SK, van Puijenbroek E. Medication errors by caregivers in the homes of children discharged from a pediatric department in Ghana. Ther Adv Drug Saf 2024; 15:20420986231225850. [PMID: 38293565 PMCID: PMC10823839 DOI: 10.1177/20420986231225850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/24/2023] [Indexed: 02/01/2024] Open
Abstract
Background Medication errors (MEs) by caregivers at home are a cause of morbidity and mortality, shortly after discharge from the hospital. Objectives The objective of this study was to determine the rate and types of MEs at the homes of children discharged from a hospital in Ghana and to explore the factors associated with these errors. Design This was a cross-sectional study of infants and children discharged from the hospital to review medication administration practices. Methods Caregivers of children discharged from the hospital after at least 24 hours of admission were interviewed at their homes about medication administration practices. The study assessed potential harm associated with MEs made by caregivers using the Harm Associated with Medication Error Classification tool. The Least Absolute Shrinkage and Selection Operator regression were used to identify the variables associated with MEs. Results A total of 95 children (mean age: 28.6 months, 52.6% female) and their caregivers were included. Overall, 65 (68.4%) children experienced one or more MEs. Out of a total of 232 medications reviewed, 102 (44.0%) (95% CI: 37.6-50.4) were associated with a ME. The top two errors, wrong time errors and errors in the frequency of dosing were, 45.1% and 21.6%, respectively. Understanding the information on the disease condition being treated and the medicines dispensed was associated with committing fewer MEs. The number of medicines prescribed was associated with a higher likelihood of MEs. Out of 102 MEs, 48 (47.1%) were assessed as posing potentially no harm, 26 (25.5%) minor harm, 15 (14.7%) moderate harm, and 13 (12.8%) serious harm to the patients. Importantly, none of the MEs were assessed as posing potentially severe or life-threatening harm to the patients. Conclusion MEs in children following discharge are high, and systems should be developed to prevent these errors.
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Affiliation(s)
- George Tsey Sabblah
- Food and Drugs Authority, P.O. Box CT 2783, Cantonments, Accra, Ghana
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
| | - Katja Taxis
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Mahama Duwiejua
- School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Eugène van Puijenbroek
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
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Carroll AR, Johnson JA, Stassun JC, Greevy RA, Mixon AS, Williams DJ. Health Literacy-Informed Communication to Reduce Discharge Medication Errors in Hospitalized Children: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350969. [PMID: 38227315 PMCID: PMC10792470 DOI: 10.1001/jamanetworkopen.2023.50969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/20/2023] [Indexed: 01/17/2024] Open
Abstract
Importance Inadequate communication between caregivers and clinicians at hospital discharge contributes to medication dosing errors in children. Health literacy-informed communication strategies during medication counseling can reduce dosing errors but have not been tested in the pediatric hospital setting. Objective To test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. Design, Setting, and Participants This parallel, randomized clinical trial was performed from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Interventions Permuted block (n = 4) randomization (1:1) to a health literacy-informed discharge medication communication bundle (n = 99) compared with standard counseling (n = 99). A study team member delivered the intervention consisting of a written, pictogram-based medication instruction sheet, teach back (caregivers state information taught), and demonstration of dosing with show back (caregivers show how they would draw the liquid medication in the syringe). Main Outcome and Measures Observed dosing errors, assessed using a caregiver-submitted photograph of their child's medication-filled syringe and expressed as the percentage difference from the prescribed dose. Secondary outcomes included caregiver-reported medication knowledge. Outcome measurements were blinded to participant group assignment. Results Among 198 caregivers randomized (mean [SD] age, 31.4 [6.5] years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 [95% CI, 1.0-3.6] percentage points; P < .001). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group (P = .003). The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]; P = .03), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%]; P = .04), and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]; P < .001). There were no differences in knowledge of medication name, indication, frequency, or storage. Conclusions and Relevance A health literacy-informed discharge medication communication bundle reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling. Routine use of these standardized strategies can promote patient safety following hospital discharge. Trial Registration ClinicalTrials.gov Identifier: NCT05143047.
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Affiliation(s)
- Alison R. Carroll
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jakobi A. Johnson
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Justine C. Stassun
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amanda S. Mixon
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Internal Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Derek J. Williams
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee
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Jolliff A, Coller RJ, Kearney H, Warner G, Feinstein JA, Chui MA, O'Brien S, Willey M, Katz B, Bach TD, Werner NE. An mHealth Design to Promote Medication Safety in Children with Medical Complexity. Appl Clin Inform 2024; 15:45-54. [PMID: 37989249 PMCID: PMC10794091 DOI: 10.1055/a-2214-8000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Children with medical complexity (CMC) are uniquely vulnerable to medication errors and preventable adverse drug events because of their extreme polypharmacy, medical fragility, and reliance on complicated medication schedules and routes managed by undersupported family caregivers. There is an opportunity to improve CMC outcomes by designing health information technologies that support medication administration accuracy, timeliness, and communication within CMC caregiving networks. OBJECTIVES The present study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a codesign process to identify: (1) medication safety challenges experienced by CMC caregivers and (2) design requirements for a mobile health application to improve medication safety for CMC in the home. METHODS Study staff recruited family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program to participate in virtual codesign sessions. During sessions, the facilitator-guided codesigners in generating and converging upon medication safety challenges and design requirements. Between sessions, the research team reviewed notes from the session to identify design specifications and modify the prototype. After design sessions concluded, each session recording was reviewed to confirm that all designer comments had been captured. RESULTS A total of N = 16 codesigners participated. Analyses yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines. Supporting quotations from codesigners and prototype features associated with each design requirement are presented. CONCLUSION This study generated design requirements for a tool that may improve medication safety by creating distributed situation awareness within the caregiving network. The next steps are to pilot test tools that integrate these design requirements for usability and feasibility, and to conduct a randomized control trial to determine if use of these tools reduces medication errors.
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Affiliation(s)
- Anna Jolliff
- Department of Health and Wellness Design, Indiana University at Bloomington, Bloomington, Indiana, United States
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Hannah Kearney
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - James A. Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Michelle A. Chui
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Steve O'Brien
- Noble Applications, Madison, Wisconsin, United States
| | - Misty Willey
- Noble Applications, Madison, Wisconsin, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, Wisconsin, United States
| | - Theodore D. Bach
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Nicole E. Werner
- Department of Health and Wellness Design, Indiana University at Bloomington, Bloomington, Indiana, United States
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Coller RJ, Green HD, Kaminski PC, Howell K, Alfaro E, Nelson C, Warner G, Werner NE. Feasibility of social network analysis to study outcomes of children with medical complexity. J Hosp Med 2024; 19:35-39. [PMID: 37880922 PMCID: PMC10843286 DOI: 10.1002/jhm.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
Since most care for children with medical complexity (CMC) is delivered daily in communities by multiple caregiving individuals, that is, caregiving networks, tools to assess and intervene across these networks are needed. This study evaluated the feasibility of applying social network analysis (SNA) to describe caregiving networks. Because hospitalization is among the most frequently used outcomes for CMC, exploratory correlations between network characteristics and CMC hospital use were evaluated. Within 3 weeks, the goal network enrollment was achieved, and all feasibility measures were favorable. Network characteristics correlated with hospital use, that is, smaller, denser networks, with more closed-loop communication correlated with fewer hospital days. Networks with more professional caregivers also correlated with fewer hospital days. SNA is a feasible tool to study CMC caregiving networks. Preliminary data support rigorous hypothesis testing using SNA methods. Network-based interventions to improve CMC health may be an important future direction.
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Affiliation(s)
- Ryan J. Coller
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Harold D. Green
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Patrick C. Kaminski
- Indiana University Luddy School of Informatics, Computing, and Engineering, Indiana, USA
| | - Kristina Howell
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Elena Alfaro
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Cassandra Nelson
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Gemma Warner
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nicole E. Werner
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
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Rickey L, Auger K, Britto MT, Rodgers I, Field S, Odom A, Lehr M, Cronin A, Walsh KE. Measurement of Ambulatory Medication Errors in Children: A Scoping Review. Pediatrics 2023; 152:e2023061281. [PMID: 37986581 DOI: 10.1542/peds.2023-061281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children use most medications in the ambulatory setting where errors are infrequently intercepted. There is currently no established measure set for ambulatory pediatric medication errors. We have sought to identify the range of existing measures of ambulatory pediatric medication errors, describe the data sources for error measurement, and describe their reliability. METHODS We performed a scoping review of the literature published since 1986 using PubMed, CINAHL, PsycINFO, Web of Science, Embase, and Cochrane and of grey literature. Studies were included if they measured ambulatory, including home, medication errors in children 0 to 26 years. Measures were grouped by phase of the medication use pathway and thematically by measure type. RESULTS We included 138 published studies and 4 studies from the grey literature and identified 21 measures of medication errors along the medication use pathway. Most measures addressed errors in medication prescribing (n = 6), and administration at home (n = 4), often using prescription-level data and observation, respectively. Measures assessing errors at multiple phases of the medication use pathway (n = 3) frequently used error reporting databases and prospective measurement through direct in-home observation. We identified few measures of dispensing and monitoring errors. Only 31 studies used measurement methods that included an assessment of reliability. CONCLUSIONS Although most available, reliable measures are too resource and time-intensive to assess errors at the health system or population level, we were able to identify some measures that may be adopted for continuous measurement and quality improvement.
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Affiliation(s)
- Lisa Rickey
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Katherine Auger
- Division of Hospital Medicine
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maria T Britto
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Isabelle Rodgers
- Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - Shayna Field
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alayna Odom
- Division of Hospital Medicine
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Madison Lehr
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Phillips S, Schlenz AM, D'Alton S, Johnson M, Kanter J. Patient and Family Opioid Decision-Making for Pain Management in Sickle Cell Disease: A Qualitative Study. THE JOURNAL OF PAIN 2023; 24:1240-1250. [PMID: 36863679 PMCID: PMC10329994 DOI: 10.1016/j.jpain.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
Pain is a significant symptom experienced frequently by individuals with sickle cell disease (SCD). Pain management includes strategies such as oral rehydration, non-pharmacological therapies (eg, massage, relaxation), and oral analgesics and opioids. Shared decision-making around pain management is emphasized repeatedly in recent guidelines; however, research is sparse regarding factors to be considered in shared decision-making approaches including the perceived risks and benefits of opioids. This qualitative descriptive study was conducted to explore perspectives of decision-making for opioid medications in SCD. We conducted 20 in-depth interviews with caregivers of children with SCD and individuals with SCD to elucidate the decision-making processes around home use of opioid therapy for pain management at a single center. Themes were identified in the domains of the Decision Problem (Alternatives and Choices; Outcomes and Consequences; Complexity), the Context (Multilevel Stressors and Supports; Information; Patient-Provider Interactions), and the Patient (Decision-Making Approaches; Developmental Status; Personal and Life Values; Psychological State). Key findings indicated opioid management for pain in SCD is important yet complex and requires collaboration among patients, families, and providers. Elements of patient and caregiver decision-making identified in this study may be applied to shared decision-making strategies in the clinical setting and future study. PERSPECTIVE: This study illustrates the factors involved in decision-making around home opioid use for pain management in children and young adults with SCD. These findings can be applied to determining shared decision-making approaches around pain management between providers and patients, in accordance with recent SCD pain management guidelines.
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Affiliation(s)
- Shannon Phillips
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina.
| | - Alyssa M Schlenz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Shannon D'Alton
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Mary Johnson
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Julie Kanter
- Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, Alabama
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Kirkendall ES, Brady PW, Corathers SD, Ruddy RM, Fox C, Nelson H, Wetterneck TB, Rodgers I, Walsh KE. Safer Type 1 Diabetes Care at Home: SEIPS-based Process Mapping with Parents and Clinicians. Pediatr Qual Saf 2023; 8:e649. [PMID: 38571735 PMCID: PMC10990404 DOI: 10.1097/pq9.0000000000000649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/02/2023] [Indexed: 04/05/2024] Open
Abstract
Introduction The limited data indicate that pediatric medical errors in the outpatient setting, including at home, are common. This study is the first step of our Ambulatory Pediatric Patient Safety Learning Lab to address medication errors and treatment delays among children with T1D in the outpatient setting. We aimed to identify failures and potential solutions associated with medication errors and treatment delays among outpatient children with T1D. Methods A transdisciplinary team of parents, safety researchers, and clinicians used Systems Engineering Initiative for Patient Safety (SEIPS) based process mapping of data we collected through in-home medication review, observation of administration, chart reviews, parent surveys, and failure modes and effects analysis (FMEA). Results Eight (57%) of the 14 children who had home visits experienced 18 errors (31 per 100 medications). Four errors in two children resulted in harm, and 13 had the potential for harm. Two injuries occurred when parents failed to treat severe hypoglycemia and lethargy, and two were due to repeated failures to administer insulin at home properly. In SEIPS-based process maps, high-risk errors occurred during communication between the clinic and home or in management at home. Two FMEAs identified interventions to better communicate with families and support home care, especially during evolving illness. Conclusion Using SEIPS-based process maps informed by multimodal methods to identify medication errors and treatment delays, we found errors were common. Better support for managing acute illness at home and improved communication between the clinic and home are potentially high-yield interventions.
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Affiliation(s)
- Eric S. Kirkendall
- From the Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, N.C
- Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, N.C
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, N.C
| | - Patrick W. Brady
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center of Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah D. Corathers
- James M. Anderson Center of Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Richard M. Ruddy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Catherine Fox
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Hailee Nelson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tosha B. Wetterneck
- Department of Medicine, Division of General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Isabelle Rodgers
- Division of General Pediatrics, Harvard Medical School, Boston, Mass
- Department of Pediatrics, Boston Children’s Hospital, Boston, Mass
| | - Kathleen E. Walsh
- Division of General Pediatrics, Harvard Medical School, Boston, Mass
- Department of Pediatrics, Boston Children’s Hospital, Boston, Mass
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Orth LE, Feudtner C, Kempe A, Morris MA, Colborn KL, Gritz RM, Linnebur SA, Begum A, Feinstein JA. A coordinated approach for managing polypharmacy among children with medical complexity: rationale and design of the Pediatric Medication Therapy Management (pMTM) randomized controlled trial. BMC Health Serv Res 2023; 23:414. [PMID: 37120509 PMCID: PMC10148507 DOI: 10.1186/s12913-023-09439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Children with medical complexity (CMC) often rely upon the use of multiple medications to sustain quality of life and control substantial symptom burden. Pediatric polypharmacy (≥ 5 concurrent medications) is prevalent and increases the risk of medication-related problems (MRPs). Although MRPs are associated with pediatric morbidity and healthcare utilization, polypharmacy is infrequently assessed during routine clinical care for CMC. The aim of this randomized controlled trial is to determine if a structured pharmacist-led Pediatric Medication Therapy Management (pMTM) intervention reduces MRP counts, as well as the secondary outcomes of symptom burden and acute healthcare utilization. METHODS This is a hybrid type 2 randomized controlled trial assessing the effectiveness of pMTM compared to usual care in a large, patient-centered medical home for CMC. Eligible patients include all children ages 2-18 years old, with ≥ 1 complex chronic condition, and with ≥ 5 active medications, as well as their English-speaking primary caregivers. Child participants and their primary parental caregivers will be randomized to pMTM or usual care before a non-acute primary care visit and followed for 90 days. Using generalized linear models, the overall effectiveness of the intervention will be evaluated using total MRP counts at 90 days following pMTM intervention or usual care visit. Following attrition, a total of 296 CMC will contribute measurements at 90 days, which provides > 90% power to detect a clinically significant 1.0 reduction in total MRPs with an alpha level of 0.05. Secondary outcomes include Parent-Reported Outcomes of Symptoms (PRO-Sx) symptom burden scores and acute healthcare visit counts. Program replication costs will be assessed using time-driven activity-based scoring. DISCUSSION This pMTM trial aims to test hypotheses that a patient-centered medication optimization intervention delivered by pediatric pharmacists will result in lower MRP counts, stable or improved symptom burdens, and fewer cumulative acute healthcare encounters at 90 days following pMTM compared to usual care. The results of this trial will be used to quantify medication-related outcomes, safety, and value for a high-utilization group of CMC, and outcomes may elucidate the role of integrated pharmacist services as a key component of outpatient complex care programs for this priority pediatric population. TRIAL REGISTRATION This trial was prospectively registered at clinicaltrials.gov (NCT05761847) on Feb 25, 2023.
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Affiliation(s)
- Lucas E Orth
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO, USA
| | - Chris Feudtner
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Departments of Pediatrics and Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison Kempe
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Megan A Morris
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn L Colborn
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - R Mark Gritz
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sunny A Linnebur
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anowara Begum
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA
| | - James A Feinstein
- Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 1890 N. Revere Court, 3Rd Level, Mail Stop F443, Aurora, CO, 80045, USA.
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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10
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Wong CI, Vannatta K, Gilleland Marchak J, Quade EV, Rodgers IM, Reid CM, Dandoy CE, Billett AL, Miller TP, Vaughn S, Daraiseh NM, Liu S, Carle AC, Walsh KE. Preventable harm because of outpatient medication errors among children with leukemia and lymphoma: A multisite longitudinal assessment. Cancer 2023; 129:1064-1074. [PMID: 36704995 DOI: 10.1002/cncr.34651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND There is little longitudinal information about the type and frequency of harm resulting from medication errors among outpatient children with cancer. We aimed to characterize rates and types of medication errors and harm to outpatient children with leukemia and lymphoma over 7 months of treatment. METHODS We recruited children taking medications at home for leukemia or lymphoma from three pediatric cancer centers. Errors were identified by chart review, in-home medication review, observation of administration, and interviews. Physician reviewers confirmed error (Fleiss' κ = 0.95), harm (Fleiss' κ = 0.82), and suggested interventions. Generalized linear mixed models with random effects were used to account for clustering by site. RESULTS Among 131 children taking 1669 medications with 367 home visits, 408 errors were identified, including 242 with potential for harm and 39 with harm (1.0 harm per 1000 patient-days [95% CI, 0.1-9.8]). Ten percent of children were injured by errors and 42% had errors with potential for harm. Twenty-six percent of caregivers reported that miscommunication led to missed doses or overdoses at home. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%). CONCLUSIONS In this longitudinal study, 10% children with leukemia or lymphoma experienced adverse drug events because of outpatient medication errors. Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering. PLAIN LANGUAGE SUMMARY In this longitudinal study, medication errors in the clinic, pharmacy, or at home among children with leukemia or lymphoma over a 7-month period were common, and 10% suffered harm because of errors. Children on >13 medications had significantly more serious medication errors than those on fewer medications (77% vs 61%; p = .05). Physician reviewers judged that improved communication among caregivers and between caregivers and clinicians may have prevented the most harm (66%). Improvements addressing communication with and among caregivers should be codeveloped with families and based on human-factors engineering.
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Affiliation(s)
- Chris I Wong
- Pediatric Hematology-Oncology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
- Medical Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Emeric V Quade
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Isabelle M Rodgers
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christine M Reid
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher E Dandoy
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amy L Billett
- Quality and Safety Program, Nemours Children's Health, Delaware Valley, Wilmington, Delaware, USA
| | - Tamara P Miller
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Shelley Vaughn
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nancy M Daraiseh
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shanshan Liu
- Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Institutional Centers for Clinical Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adam C Carle
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- College of Medicine University of Cincinnati, Cincinnati, Ohio, USA
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kathleen E Walsh
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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11
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Garrity BM, Perrin JM, Rodean J, Houtrow AJ, Shelton C, Stille C, McLellan S, Coleman C, Mann M, Kuhlthau K, Desmarais A, Berry JG. Annual Days With a Health Care Encounter for Children and Youth Enrolled in Medicaid: A Multistate Analysis. Acad Pediatr 2023; 23:441-447. [PMID: 35863733 DOI: 10.1016/j.acap.2022.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To assess the number of days that children experienced a health care encounter and associations between chronic condition types and health care encounters. METHODS Retrospective analysis of data from 5,082,231 children ages 0 to 18 years enrolled in Medicaid during 2017 in 12 US states contained in the IBM Watson Marketscan Medicaid Database. We counted and categorized enrollees' encounter days, defined as unique days a child had a health care visit, by type of health service. We used International Classification of Disease-10 diagnosis code categories from Agency for Healthcare Research and Quality's Chronic Condition Indicator System to identify chronic mental and physical health conditions. RESULTS Median (interquartile range [IQR]) annual encounter days was 6 (2-13). Children in the 91st to 98th and ≥99th percentiles for encounter days experienced a median of 49 (IQR 38-70) and 229 (IQR 181, 309) days, respectively; these children accounted for 52.6% of days for the cohort. As encounter days increased from the 25th to >90th percentile, the percentage of children with co-existing mental and physical health conditions increased from <0.1% to 47.4% (P < .001). Outpatient visits accounted for a total of 68.3% and 62.2% of days for children the 91st to 98th and ≥99th percentiles. CONCLUSION Ten percent of children enrolled in Medicaid averaged health care encounters at least 1 day per week; 1% experienced health care encounters on most weekdays. Further investigation is needed to understand how families perceive frequent health care encounters, including how to facilitate their children's care in the most feasible way.
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Affiliation(s)
- Brigid M Garrity
- Division of General Pediatrics, Boston Children's Hospital (BM Garrity, A Desmarais, and JG Berry), Boston, Mass.
| | - James M Perrin
- Division of General Academic Pediatrics, MassGeneral Hospital for Children (JM Perrin), Boston, Mass; Department of Pediatrics, Harvard Medical School (JM Perrin and JG Berry), Boston, Mass
| | | | - Amy J Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh (AJ Houtrow), Pittsburgh, Pa
| | - Charlene Shelton
- School of Medicine, University of Colorado Anschutz Medical Campus (C Shelton and C Stille), Aurora, Colo
| | - Christopher Stille
- School of Medicine, University of Colorado Anschutz Medical Campus (C Shelton and C Stille), Aurora, Colo; General Academic Pediatrics, Children's Hospital Colorado (C Stille), Denver, Colo
| | - Sarah McLellan
- Health Resources and Services Administration, Maternal and Child Health Bureau (S McLellan), Rockville, Md
| | - Cara Coleman
- Family Voices National (C Coleman), Washington, DC
| | - Marie Mann
- Health Resources and Services Administration (M Mann), Rockville, Md
| | - Karen Kuhlthau
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School (K Kuhlthau), Boston, Mass
| | - Anna Desmarais
- Division of General Pediatrics, Boston Children's Hospital (BM Garrity, A Desmarais, and JG Berry), Boston, Mass
| | - Jay G Berry
- Division of General Pediatrics, Boston Children's Hospital (BM Garrity, A Desmarais, and JG Berry), Boston, Mass; Department of Pediatrics, Harvard Medical School (JM Perrin and JG Berry), Boston, Mass
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12
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Feinstein JA, Orth LE. Making Polypharmacy Safer for Children with Medical Complexity. J Pediatr 2023; 254:4-10. [PMID: 36252865 PMCID: PMC10023276 DOI: 10.1016/j.jpeds.2022.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
Abstract
A 14-year-old patient who has severe cerebral palsy and seizures, requested that his parents speak to his pediatrician about a medication to help with sleep. He already uses 13 other medications, including anticonvulsants, analgesics, and respiratory medications, and 5 additional as needed (PRN) medications (Figure 1 ). He has a vagal nerve stimulator and a gastrostomy tube. His parents had researched several sleep medications, and they were interested in discussing trazodone therapy for his sleep issues. Clinicians who prescribe medications to children with medical complexity (CMC) frequently must consider the question: How does one safely prescribe a patient like ours a new medication, like the sleep medication trazodone, amidst an already complex background of polypharmacy?
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Affiliation(s)
- James A Feinstein
- Adult and Child Consortium for Health Outcomes Research & Delivery Science (ACCORDS), University of Colorado and Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado, Aurora, CO.
| | - Lucas E Orth
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of Colorado, Aurora, CO
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13
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Tiozzo E, Rosati P, Brancaccio M, Biagioli V, Ricci R, d'Inzeo V, Scarselletta G, Piga S, MSc S, Vanzi V, Dall'Oglio I, Gawronski O, Offidani C, Pulimeno MA, Raponi M. A Cell-Phone Medication Error eHealth App for Managing Safety in Chronically Ill Young Patients at Home: A Prospective Study. Telemed J E Health 2022; 29:584-592. [PMID: 36070555 DOI: 10.1089/tmj.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Whereas ample information describes medication errors (MEs) in children or in mixed pediatric and adult populations discharged with acute or chronic diseases from hospital to community settings, little is known about MEs in children and adolescents with chronic diseases discharged home, a major concern. To promote home medication safety, we trained parents of children discharged with chronic diseases to record ME with a tailored cell-phone eHealth app. Methods: In a 1-year prospective study, we used the app to monitor ME in patients with chronic diseases discharged home from a tertiary hospital in Rome, Italy. Univariate and multivariate analyses detected the ME incidence rate ratio (IRR). Results: Of the 310 parents enrolled, 194 used the app. The 41 MEs involved all drug management phases. The ME IRR was 0.46 errors per child. Children <1 year had the highest ME risk (1.69 vs. 0.35, p = 0.002). Children discharged from the cardiology unit had a statistically higher ME IRR than others (3.66, 95% confidence interval: 1.01-13.23%). Conclusions: The highest ME risk at home involves children with chronic diseases <1 year old. A significant ME IRR at home concerns children with heart diseases of any age. Parents find a tailored eHealth app for monitoring and reporting ME at home easy to use. At discharge, clinical teams need to identify age-related and disease-residual risks to target additional actions for monitoring ME, thus increasing medication safety at home.
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Affiliation(s)
- Emanuela Tiozzo
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Rosati
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Matilde Brancaccio
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Critical Care Department, Sant'Andrea Hospital, Rome, Italy
| | - Valentina Biagioli
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Victoria d'Inzeo
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gianna Scarselletta
- Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Stat MSc
- Clinical Pathways and Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Vanzi
- University Department of Pediatrics, and Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Offidani
- Unit of Legal Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Ausilia Pulimeno
- Center of Excellence for Nursing Scholarship, Nursing Professions Order of Rome (OPI), Rome, Italy
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14
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Alghamdi K, Lysecki D. Role of gabapentin in reducing the need for high-risk medications in patients with stable severe neurological impairment. J Taibah Univ Med Sci 2022; 18:170-174. [DOI: 10.1016/j.jtumed.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 10/15/2022] Open
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15
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Ni XF, Yang CS, Zeng LN, Li HL, Diao S, Li DY, Wu J, Liu YC, Jia ZJ, Cheng G, Zhang LL. Drug-Related Problems of Children With Chronic Diseases in a Chinese Primary Health Care Institution: A Cross-Sectional Study. Front Pharmacol 2022; 13:874948. [PMID: 35924066 PMCID: PMC9342849 DOI: 10.3389/fphar.2022.874948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Drug-related problems (DRPs) refer to events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. DRPs might be severe for children with chronic diseases managed at primary health care institutions, but the relevant research is scarce. Objective: In this cross-sectional study, we aimed to explore the prevalence, types, causes, and influencing factors of DRPs in children with chronic diseases in a Chinese primary health care institution. Methods: We recruited children with chronic diseases who visited the pediatric outpatient department in a primary health care institution from July 1 to 12 October 2021. Clinical pharmacists identified DRPs through medication therapy reviews, classified the types and causes of DRPs, and distinguished the manifested DRPs that affected the outcome and potential DRPs that were going to affect the outcome. Results: A total of 188 children with chronic diseases was included, and 584 DRPs were identified in 89.89% of participants. The most common type of DRPs was "treatment effectiveness" (a manifested problem or potential problem with the effect of the pharmacotherapy; 83.56%), of which 67.29% were potential DRPs. The second common type was "treatment safety" (patient suffers or could suffer from an adverse drug event; 14.21%), of which 89.16% were potential DRPs. The most common cause of DRPs was related to the process of use (42.24%), such as "patient uses/takes less drug than prescribed or does not take the drug at all," "patient stores drug inappropriately," and "patient administers/uses the drug in a wrong way." The second common cause was related to the process of dispensing (29.83%), such as "necessary information not provided or incorrect advice provided" and "prescribed drug is not available." The third common cause was related to the process of prescribing (26.21%), such as "drug dose is too low" and "no or incomplete drug treatment despite an existing indication." The number of combined medications was an influencing factor for the frequency of DRPs (p < 0.05). Conclusion: This cross-sectional study showed that the current situation regarding DRPs among children with chronic diseases managed in the primary health care institution was serious. The types of DRPs were mainly related to treatment effectiveness, and improper usage of medications was one of the main causes of DRPs. The number of combined drugs was the influencing factor for the frequency of DRPs. In the future, pharmacists should consider formulating pharmaceutical intervention strategies for this specific group according to the characteristics of DRPs.
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Affiliation(s)
- Xiao-Feng Ni
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Chun-Song Yang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Li-Nan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Hai-Long Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Sha Diao
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - De-Yuan Li
- Pediatric Intensive Care, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Jin Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuan-Chun Liu
- Zigong Da’an Maternity and, Child Health Care Hospital, Zigong, China
| | - Zhi-Jun Jia
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Guo Cheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Sichuan University, Chengdu, China
| | - Ling-Li Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
- China Center for Evidence-based Medicine, West China Hospital, Sichuan University, Chengdu, China
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16
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Al Khayrallah Z, Al-Saeedy Z, Medriano RAA, Lee K, Sommerfield A, Sommerfield D, Ware B, Huppatz D, Campbell A, Lim LY, von Ungern-Sternberg BS. Prescribing in a pediatric hospital setting - Lost in translation? PATIENT EDUCATION AND COUNSELING 2022; 105:1614-1619. [PMID: 34688523 DOI: 10.1016/j.pec.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine parental understanding of directions on common pediatric prescription pharmacy labels and to identify enablers and barriers that affect interpretation of these labels. METHODS Prospective qualitative descriptive study (July to August 2020) of 20 parents in post-surgical wards at a single Australian tertiary pediatric center. RESULTS Four key themes emerged through inductive analysis of the interview transcripts: 1) the addition of specific directions, such as administration with/without food and treatment course duration were perceived to be beneficial; 2) explicit phrasing of dosing intervals and times were more easily interpreted; 3) the use of simpler and common terminology enhanced understanding of the directions; and 4) presentation of multiple-step directions (e.g. tapering regimens) in a simplified and more organized manner was identified as an enabler and was thought to reduce confusion. CONCLUSION Differences in wording and presentation of pediatric prescription medication label directions led to variable interpretation by parents. PRACTISE IMPLICATIONS Therefore, there is a need for guidelines to standardize the wording of prescription medication advice labels. Findings from this study can be used to achieve this goal.
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Affiliation(s)
- Zainab Al Khayrallah
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia; Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Zahraa Al-Saeedy
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Rose Ann Ayes Medriano
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia.
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia.
| | - Benjamin Ware
- Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Dean Huppatz
- Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Andrew Campbell
- Pharmacy Department, Sir Charles Gairdner Hospital, Nedlands, Australia.
| | - Lee Yong Lim
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia.
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17
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Lawrence PR, Spratling R. A Theory for Understanding Parental Workload and Capacity to Care for Children With Medical Complexity. Res Theory Nurs Pract 2022; 36:34-46. [PMID: 35173026 DOI: 10.1891/rtnp-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Children with medical complexity (CMC) experience poor health outcomes despite the high cost of care, and their parents face challenges in providing complex care. Poor health outcomes may be related to an imbalance between parental demands to manage care and their ability to meet the demands needed to provide complex care. However, this phenomenon has not been explored. In addition, much of the existing research focused on CMC lacks an overarching theoretical framework. The purpose of this article is to outline factors that impact families of CMC described in the literature. This article proposes a modified framework using theory derivation, which highlights the concepts of parental workload and capacity and demonstrates how they are related to CMC health. METHODS A revised theoretical framework using theory derivation by Walker and Avant is presented using findings from the CMC literature that most affect the parents of these children. RESULTS Applying content from two existing theories using concepts of relevance results in a framework that provides richer insight into the relationship between parental workload and parental capacity, particularly when parental workload outweighs parental capacity. This framework allows for the examination of how an imbalance between workload and capacity impacts CMC health outcomes. IMPLICATIONS FOR PRACTICE Although further study is needed to test the proposed theory, the framework can be used to examine these relationships with hopes of developing interventions to decrease parental workload and enhance parental ability.
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Affiliation(s)
- Patricia R Lawrence
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Regena Spratling
- Associate Dean Chief Academic Officer for Nursing, Associate Professor, School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, USA
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18
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Blaine K, Wright J, Pinkham A, O'Neill M, Wilkerson S, Rogers J, McBride S, Crofton C, Grodsky S, Hall D, Mauskar S, Akula V, Khan A, Mercer A, Berry JG. Medication Order Errors at Hospital Admission Among Children With Medical Complexity. J Patient Saf 2022; 18:e156-e162. [PMID: 32398538 DOI: 10.1097/pts.0000000000000719] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to characterize the nature and prevalence of medication order errors (MOEs) occurring at hospital admission for children with medical complexity (CMC), as well as identify the demographic and clinical risk factors for CMC experiencing MOEs. METHODS Prospective cohort study of 1233 hospitalizations for CMC from November 1, 2015, to October 31, 2016, at 2 children's hospitals. Medication order errors at admission were identified prospectively by nurse practitioners and a pharmacist through direct patient care. The primary outcome was presence of at least one MOE at hospital admission. Statistical methods used included χ2 test, Fisher exact tests, and generalized linear mixed models. RESULTS Overall, 6.1% (n = 75) of hospitalizations had ≥1 MOE occurring at admission, representing 112 total identified MOEs. The most common MOEs were incorrect dose (41.1%) and omitted medication (34.8%). Baclofen and clobazam were the medications most commonly associated with MOEs. In bivariable analyses, MOEs at admission varied significantly by age, assistance with medical technology, and numbers of complex chronic conditions and medications (P < 0.05). In multivariable analysis, patients receiving baclofen had the highest adjusted odds of MOEs at admission (odds ratio, 2.2 [95% confidence interval, 1.2-3.8]). CONCLUSIONS Results from this study suggest that MOEs are common for CMC at hospital admission. Children receiving baclofen are at significant risk of experiencing MOEs, even when orders for baclofen are correct. Several limitations of this study suggest possible undercounting of MOEs during the study period. Further investigation of medication reconciliation processes for CMC receiving multiple chronic, home medications is needed to develop effective strategies for reducing MOEs in this vulnerable population.
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Affiliation(s)
| | - John Wright
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | | | | | - Sarah Wilkerson
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
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19
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Yin HS, Neuspiel DR, Paul IM, Franklin W, Tieder JS, Adirim T, Alvarez F, Brown JM, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Mueller BU, Connor Phillips S, Quinonez RA, Rea C, Rinke ML, Shaikh U, Shiffman RN, Vickers Saarel E, Spencer Cockerham SP, Mack Walsh K, Jones B, Adler AC, Foster JH, Green TP, Houck CS, Laughon MM, Neville K, Reigart JR, Shenoi R, Sullivan JE, Van Den Anker JN, Verhoef PA. Preventing Home Medication Administration Errors. Pediatrics 2021; 148:183379. [PMID: 34851406 DOI: 10.1542/peds.2021-054666] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.
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Affiliation(s)
- H Shonna Yin
- Departments of Pediatrics and Population Health, Grossman School of Medicine, New York University, New York, New York
| | | | - Ian M Paul
- Departments of Pediatrics and Public Health Sciences, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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20
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Ni XF, Yang CS, Bai YM, Hu ZX, Zhang LL. Drug-Related Problems of Patients in Primary Health Care Institutions: A Systematic Review. Front Pharmacol 2021; 12:698907. [PMID: 34489695 PMCID: PMC8418140 DOI: 10.3389/fphar.2021.698907] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/02/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Drug-related problems (DRPs) are not only detrimental to patients' physical health and quality of life but also lead to a serious waste of health care resources. The condition of DRPs might be more severe for patients in primary health care institutions. Objective: This systematic review aims to comprehensively review the characteristics of DRPs for patients in primary health care institutions, which might help find effective strategies to identify, prevent, and intervene with DRPs in the future. Methods: We searched three English databases (Embase, The Cochrane Library, and PubMed) and four Chinese databases (CNKI, CBM, VIP, and Wanfang). Two of the researchers independently conducted literature screening, quality evaluation, and data extraction. Qualitative and quantitative methods were combined to analyze the data. Results: From the 3,368 articles screened, 27 met the inclusion criteria and were included in this review. The median (inter-quartile range, IQR) of the incidences of DRPs was 70.04% (59%), and the median (IQR) of the average number of DRPs per patient was 3.4 (2.8). The most common type of DRPs was “treatment safety.” The causes of DRPs were mainly in the prescribing section, including “drug selection” and “dose selection”, while patients' poor adherence in the use section was also an important cause of DRPs. Risk factors such as the number of medicines, age, and disease condition were positively associated with the occurrence of DRPs. In addition, the medians (IQR) of the rate of accepted interventions, implemented interventions, and solved DRPs were 78.8% (22.3%), 64.15% (16.85%), and 76.99% (26.09%), respectively. Conclusion: This systematic review showed that the condition of DRPs in primary health care institutions was serious. In pharmaceutical practice, the patients with risk factors of DRPs should be monitored more closely. Pharmacists could play important roles in the identification and intervention of DRPs, and more effective intervention strategies need to be established in the future.
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Affiliation(s)
- Xiao-Feng Ni
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Chun-Song Yang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China
| | - Yu-Mei Bai
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zi-Xian Hu
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Ling-Li Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education (Sichuan University), Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
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21
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Lawrence PR, Feinberg I, Spratling R. The Relationship of Parental Health Literacy to Health Outcomes of Children with Medical Complexity. J Pediatr Nurs 2021; 60:65-70. [PMID: 33621896 DOI: 10.1016/j.pedn.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
THEORETICAL PRINCIPLES Children with medical complexity experience negative health outcomes despite the high costs associated with their care. There is growing evidence that low parental health literacy is associated with a number of poor child health outcomes, including medication errors. However, less is known about the relationship between parental health literacy and the health outcomes of children with medical complexity, whose care is known to be more complex and demanding of parents. PHENOMENA ADDRESSED The challenges faced by parents of children with medical complexity are presented, including those related to communication, care coordination, and medication administration. The historical and theoretical perspectives of health literacy are discussed, and the relationship of parental health literacy to pediatric health outcomes for children with medical complexity is explored. RESEARCH LINKAGES Remaining knowledge gaps about parental health literacy and its influence on the health of children with medical complexity are outlined. Future research and clinical practice implications of health literacy and its importance to family-centered care are discussed.
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Affiliation(s)
- Patricia R Lawrence
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, GA, USA.
| | - Iris Feinberg
- College of Education and Human Development, Georgia State University, GA, USA.
| | - Regena Spratling
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, GA, USA.
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22
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Patidar P, Mathur A, Pathak A. Can use of pictograms reduce liquid medication administration errors by mothers? An interventional study. BMC Psychol 2021; 9:99. [PMID: 34172090 PMCID: PMC8228905 DOI: 10.1186/s40359-021-00584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background Liquid medication dosing errors (LMDE) made by caregivers affect treatment in children, but this is not a well-studied topic in many low-and middle-income countries including in India. Methods An intervention study was conducted among mothers attending a pediatric outpatient clinic of a tertiary care setting in Ujjain, India. The mothers randomly measured 12 volumes of a paracetamol liquid preparation by using a dropper (0.5 and 1 mL), measuring cup (2.5 and 5 mL), and calibrated spoon (2.5 and 5 mL) each with two instructions—oral-only measurement session (OMS) and oral plus pictogram measurement session (OPMS, the intervention). The main outcome was dosing error prevalence. The effectiveness of the intervention was assessed by measuring effect size. Risk factors for maximum LMDE were explored using backward multivariate logistic regression models. A P value of < 0.05 was considered statistically significant. Results In total, 310 mothers [mean (± SD) age, 30.2 (± 4.18) years] were included. LMDE prevalence in the OMS versus OPMS for dropper 0.5 mL was 60% versus 48%; for l mL dropper was 63% versus 54%; for 2.5 mL cup 62% versus 54%; for 2.5 calibrated spoon 66% versus 59%; 5 mL cup 69% versus 57%; and 5 mL calibrated spoon 68% versus 55%. Comparing OMS with OPMS, underdosing was minimum with the calibrated spoon for 2.5 mL (OR 4.39) and maximum with the dropper for 1 mL (OR 9.40), and overdosing was minimum with the dropper for 0.5 mL (OR 7.12) and maximum with the calibrated spoon for 2.5 mL (OR 13.24). The effect size (dCohen) of the intervention OPMS was 1.86–6.4. Risk factors for the most prevalent dosing error, that is, with the calibrated spoon for 2.5 mL, were increasing age of the mother (aOR 1.08; P = 0.026) and nuclear family (aOR 2.83; P = 0.002). The risk of dosing errors decreased with higher education of the mothers. Conclusions Pictograms can effectively minimize LMDE even in less educated mothers. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00584-9.
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Affiliation(s)
- Pawan Patidar
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India
| | - Aditya Mathur
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India
| | - Ashish Pathak
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India. .,Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden. .,Department of Global Public Health, Health Systems and Policy: Medicines Focusing Antibiotics, Karolinska Institutet, Stockholm, Sweden.
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23
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Azar C, Allué D, Valnet-Rabier MB, Chouchana L, Rocher F, Durand D, Grené-Lerouge N, Saleh N, Maison P. Patterns of medication errors involving pediatric population reported to the French Medication Error Guichet. Pharm Pract (Granada) 2021; 19:2360. [PMID: 34221205 PMCID: PMC8234707 DOI: 10.18549/pharmpract.2021.2.2360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/30/2021] [Indexed: 11/14/2022] Open
Abstract
Background Medication error is a global threat to patient safety, particularly in pediatrics. Yet, this issue remains understudied in this population, in both hospital and community settings. Objectives To characterize medication errors involving pediatrics reported to the French Medication Error Guichet, and compare them with medication errors in adults, in each of the hospital and community settings. Methods This was a retrospective secondary data analysis of medication errors reported throughout 2013-2017. Descriptive and multivariate analyses were performed to compare actual and potential medication error reports between pediatrics (aged <18 years) and adults (aged >18 and <60 years). Two subanalyses of actual medication errors with adverse drug reaction (ADR), and serious ADR were conducted. Results We analyzed 4,718 medication error reports. In pediatrics, both in hospital (n=791) and community (n=1,541) settings, antibacterials for systemic use (n=121, 15.7%; n=157, 10.4%, respectively) and wrong dose error type (n=391, 49.6%; n=549, 35.7%, respectively) were frequently reported in medication errors. These characteristics were also significantly more likely to be associated with reported errors in pediatrics compared with adults. In the hospital setting, analgesics (adjusted odds ratio (aOR)=1.59; 95% confidence interval (CI) 1.03:2.45), and blood substitutes and perfusion solutions (aOR=3.74; 95%CI 2.24:6.25) were more likely to be associated with reported medication errors in pediatrics; the latter drug class (aOR=3.02; 95%CI 1.59:5.72) along with wrong technique (aOR=2.28; 95%CI 1.01:5.19) and wrong route (aOR=2.74; 95%CI 1.22:6.15) error types related more to reported medication errors with serious ADR in pediatrics. In the community setting, the most frequently reported pediatric medication errors involved vaccines (n=389, 25.7%). Psycholeptics (aOR=2.42; 95%CI 1.36:4.31) were more likely to be associated with reported medication errors with serious ADR in pediatrics. Wrong technique error type (aOR=2.71; 95%CI 1.47:5.00) related more to reported medication errors with ADR in pediatrics. Conclusions We identified pediatric-specific medication error patterns in the hospital and community settings. Our findings inform focused error prevention measures, and pave the way for interventional research targeting the needs of this population.
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Affiliation(s)
- Christine Azar
- RN, MPH. Epidemiology in Dermatology and Evaluation of therapeutics, Paris-Est Creteil University. Creteil (France).
| | - Delphine Allué
- PharmD. French National Agency for Medicines and Health Products Safety (ANSM). Saint-Denis, (France).
| | - Marie B Valnet-Rabier
- MD. Regional Pharmacovigilance Center, University Hospital of Besancon. Besancon (France).
| | - Laurent Chouchana
- PharmD, PhD. Regional Pharmacovigilance Center, Cochin Hospital AP-HP.Centre - Paris University. Paris (France).
| | - Fanny Rocher
- PharmD. Regional Pharmacovigilance Center, University Hospital of Nice. Nice (France).
| | - Dorothée Durand
- PharmD. French National Agency for Medicines and Health Products Safety (ANSM). Saint-Denis, (France).
| | - Nathalie Grené-Lerouge
- PharmD. French National Agency for Medicines and Health Products Safety (ANSM). Saint-Denis, (France).
| | - Nadine Saleh
- MPH, PhD. Faculty of Public Health, Lebanese University. Fanar (Lebanon).
| | - Patrick Maison
- MD, PhD. Creteil Intercommunal Hospital Center (CHI Creteil). Creteil (France).
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24
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Chew CC, Chan HK, Chang CT, Hss AS, Hassali MA. Medication-related knowledge, administration practice and adherence among caregivers of chronically ill children in Malaysia. BMC Pediatr 2021; 21:216. [PMID: 33941117 PMCID: PMC8091478 DOI: 10.1186/s12887-021-02691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background Caregivers’ knowledge, practice and adherence in medication administration who care for children with chronic illness requiring long-term pharmacological treatments are factors associating with children medication safety at home. This study aimed to determine the medication-related knowledge, administration practice and adherence among caregivers of chronically ill children in Malaysia. This cross-sectional study was conducted at the paediatric outpatient clinic of a tertiary public hospital. Caregivers of chronically ill children, who engaged in medication administration at home for at least 3 months, were conveniently recruited. Their medication-related knowledge and administration practice were evaluated based on a checklist, while their adherence to medication administration was assessed using a validated 5-point scale. The associated factors were also explored. Results Of the 141 participants, most were mothers (90.8%) and had a full-time job (55.3%). Most of them had adequate medication-related knowledge (71.6%) and an appropriate administration practice (83.0%). The majority of them (83.0%) also rated themselves as adherent to medication administration. The participants with a child above 5 years of age (91.2%) were found to have a better practice than those with younger children (75.3%) in medication administration (p = 0.012). However, those with a child taking two (adjusted OR: 12.53) or three (adjusted OR: 8.29) medications, getting their refills from private health institutions apart from this hospital (adjusted OR = 7.06) and having multiple illnesses (adjusted OR = 21.25) were more likely to be not adherent to medication administration. Conclusion Caregivers of chronically ill children in Malaysia generally have sufficient knowledge and an appropriate practice of medication administration at home. Yet, strategies to improve the adherence to medication administration, particularly in those who care for children with complicated health conditions, are warranted.
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Affiliation(s)
- Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia. .,Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia.
| | - Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health, 05460 Alor Setar, Kedah, Malaysia
| | - Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Amar-Singh Hss
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Mohamed Azmi Hassali
- Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
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25
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Gurwitz JH, Kapoor A, Garber L, Mazor KM, Wagner J, Cutrona SL, Singh S, Kanaan AO, Donovan JL, Crawford S, Anzuoni K, Konola TJ, Zhou Y, Field TS. Effect of a Multifaceted Clinical Pharmacist Intervention on Medication Safety After Hospitalization in Persons Prescribed High-risk Medications: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:610-618. [PMID: 33646267 PMCID: PMC7922235 DOI: 10.1001/jamainternmed.2020.9285] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The National Action Plan for Adverse Drug Event (ADE) Prevention identified 3 high-priority, high-risk drug classes as targets for reducing the risk of drug-related injuries: anticoagulants, diabetes agents, and opioids. OBJECTIVE To determine whether a multifaceted clinical pharmacist intervention improves medication safety for patients who are discharged from the hospital and prescribed medications within 1 or more of these high-risk drug classes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted at a large multidisciplinary group practice in Massachusetts and included patients 50 years or older who were discharged from the hospital and prescribed at least 1 high-risk medication. Participants were enrolled into the trial from June 2016 through September 2018. INTERVENTIONS The pharmacist-directed intervention included an in-home assessment by a clinical pharmacist, evidence-based educational resources, communication with the primary care team, and telephone follow-up. Participants in the control group were provided educational materials via mail. MAIN OUTCOMES AND MEASURES The study assessed 2 outcomes over a 45-day posthospital discharge period: (1) adverse drug-related incidents and (2) a subset defined as clinically important medication errors, which included preventable or ameliorable ADEs and potential ADEs (ie, medication-related errors that may not yet have caused injury to a patient, but have the potential to cause future harm if not addressed). Clinically important medication errors were the primary study outcome. RESULTS There were 361 participants (mean [SD] age, 68.7 [9.3] years; 177 women [49.0%]; 319 White [88.4%] and 8 Black individuals [2.2%]). Of these, 180 (49.9%) were randomly assigned to the intervention group and 181 (50.1%) to the control group. Among all participants, 100 (27.7%) experienced 1 or more adverse drug-related incidents, and 65 (18%) experienced 1 or more clinically important medication errors. There were 81 adverse drug-related incidents identified in the intervention group and 72 in the control group. There were 44 clinically important medication errors in the intervention group and 45 in the control group. The intervention did not significantly alter the per-patient rate of adverse drug-related incidents (unadjusted incidence rate ratio, 1.13; 95% CI, 0.83-1.56) or clinically important medication errors (unadjusted incidence rate ratio, 0.99; 95% CI, 0.65-1.49). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, there was not an observed lower rate of adverse drug-related incidents or clinically important medication errors during the posthospitalization period that was associated with a clinical pharmacist intervention. However, there were study recruitment challenges and lower than expected numbers of events among the study population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02781662.
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Affiliation(s)
- Jerry H Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester.,Reliant Medical Group, Worcester, Massachusetts
| | - Alok Kapoor
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Lawrence Garber
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Reliant Medical Group, Worcester, Massachusetts
| | - Kathleen M Mazor
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Joann Wagner
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Sarah L Cutrona
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Sonal Singh
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Abir O Kanaan
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Massachusetts College of Pharmacy and Health Sciences, Worcester
| | - Jennifer L Donovan
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Sybil Crawford
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Kathryn Anzuoni
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Timothy J Konola
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Yanhua Zhou
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
| | - Terry S Field
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester.,Department of Medicine, University of Massachusetts Medical School, Worcester
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26
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Walsh KE, Bacic J, Phillips BD, Adams WG. Misuse of Pediatric Medications and Parent-Physician Communication: An Interactive Voice Response Intervention. J Patient Saf 2021; 17:e207-e213. [PMID: 28333698 PMCID: PMC5610049 DOI: 10.1097/pts.0000000000000375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children take 1 medication each week on average at home. Better communication between parents and providers could support safer home medication use and prevent misuse of pediatric medications, such as intentional underdosing or overdosing. Our primary objective was to assess the impact of an interactive voice response system on parent-provider communication about medications. METHODS Parents of children 4 months to 11 years of age with upcoming well child visits were invited to call our interactive voice response system, called Personal Health Partner (PHP), which asked questions about the child's health and medication use. Responding parents were randomized to either PHP (interview and counseling) or control (injury prevention survey). Parents' responses were embedded in the electronic health record. After the physical visit, research assistants performed a phone follow-up survey. RESULTS Of 475 parents, including 293 PHPs and 182 controls, 93% were women. We found a high prevalence of misuse of medications: 14% reported underdosing (n = 63) fever-reducer medications and 3% reported overdosing (n = 13). Twenty percent (n = 37) of the 190 children younger than 3 years had received cold medication. Thirty-three percent (n = 19) of 62 PHP parents of children on prescription medications reported nonadherence. Among children on prescription medications, PHP significantly increased discussion of medications at the physical, but not the number who brought medications to the visit; it had no impact on those not on prescription medications. CONCLUSIONS Pediatric medication misuse was common in this study. Use of a previsit interactive voice response system increased medication-related communication during visits and supports the need for systems that better prepare patients for visits and improve medication-related patient-physician communication.
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Affiliation(s)
| | - Janine Bacic
- Department of Health Policy and Management, Boston University, Boston, Massachusetts
| | - Barrett D Phillips
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - William G Adams
- Department of Pediatrics, Boston University, Boston, Massachusetts
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27
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Huth K, Hotz A, Starmer AJ. Patient Safety in Ambulatory Pediatrics. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2020; 6:350-365. [PMID: 38624507 PMCID: PMC7553853 DOI: 10.1007/s40746-020-00213-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 05/16/2023]
Abstract
Purpose of Review The majority of patient care occurs in the ambulatory setting, and pediatric patients are at high risk of medical error and harm. Prior studies have described various safety threats in ambulatory pediatrics, and little is known about effective strategies to minimize error. The purpose of this review is to identify best practices for optimizing safety in ambulatory pediatrics. Recent Findings The majority of the patient safety literature in ambulatory pediatrics describes frequencies and types of medical errors. Study of effective interventions to reduce error, and particularly to reduce harm, have been limited. There is evidence that medical complexity and social context are important modifiers of risk. Telemedicine has emerged as a care delivery model with potential to ameliorate and exacerbate safety threats. Though there is variation across studies, developing a safety culture, partnerships with patients and families, and use of structured communication are strategies that support patient safety. Summary There is no standardized taxonomy for errors in ambulatory pediatrics, but errors related to medications, vaccines, diagnosis, and care coordination and care transitions are commonly described. Evidence-based approaches to optimize safety include standardized prescribing and medication reconciliation practices, appropriate use of decision support tools in the electronic health record, and communication strategies like teach-back. Further high-quality intervention studies in pediatric ambulatory care that assess impact on patient harm and clinical outcomes should be prioritized.
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Affiliation(s)
- Kathleen Huth
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA
| | - Arda Hotz
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA
| | - Amy J. Starmer
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA USA
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Abebe E, Scanlon MC, Lee KJ, Chui MA. What do family caregivers do when managing medications for their children with medical complexity? APPLIED ERGONOMICS 2020; 87:103108. [PMID: 32501256 DOI: 10.1016/j.apergo.2020.103108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/13/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
Using a work domain analysis and complementary thematic analysis, this paper aims to describe medication management work, its constraints, and complexities from the perspectives of family caregivers of children with medical complexity-a medically fragile segment of the pediatric population often dependent on multiple and complex medication regimens for survival and optimal functioning. Analyses were informed by data generated through observations of 12 care coordination clinic visits within a pediatric complex care program, semi-structured interviews of 11 family caregivers, and reviews of program documents. Our results show that family caregivers: (1) formulate medication management goals, identify values and criteria to judge goals but these may not necessarily be acknowledged and explicitly supported by system resources and healthcare professionals (2) are engaged in a range of complex medication management tasks that are both physically and emotionally demanding without the support of well-designed tools and resources to enhance their work.
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Affiliation(s)
- Ephrem Abebe
- Purdue University, Department of Pharmacy Practice, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, United States.
| | | | - K Jane Lee
- Medical College of Wisconsin, United States
| | - Michelle A Chui
- University of Wisconsin - Madison, School of Pharmacy, Madison, United States
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29
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Walsh KE, Marsolo KA, Davis C, Todd T, Martineau B, Arbaugh C, Verly F, Samson C, Margolis P. Accuracy of the medication list in the electronic health record-implications for care, research, and improvement. J Am Med Inform Assoc 2019; 25:909-912. [PMID: 29771350 DOI: 10.1093/jamia/ocy027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 05/10/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Electronic medication lists may be useful in clinical decision support and research, but their accuracy is not well described. Our aim was to assess the completeness of the medication list compared to the clinical narrative in the electronic health record. Methods We reviewed charts of 30 patients with inflammatory bowel disease (IBD) from each of 6 gastroenterology centers. Centers compared IBD medications from the medication list to the clinical narrative. Results We reviewed 379 IBD medications among 180 patients. There was variation by center, from 90% patients with complete agreement between the medication list and clinical narrative to 50% agreement. Conclusions There was a range in the accuracy of the medication list compared to the clinical narrative. This information may be helpful for sites seeking to improve data quality and those seeking to use medication list data for research or clinical decision support.
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Affiliation(s)
- Kathleen E Walsh
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Keith A Marsolo
- Department of Biomedical Informatics and Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Cori Davis
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, MI, USA
| | - Theresa Todd
- Department of Pediatrics, Division of Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Bernadette Martineau
- Department of Pediatrics, Children's Specialty Services, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Carlie Arbaugh
- Department of Pediatrics, Program for Patient Safety and Quality, Boston Children's Hospital, Boston, MA, USA
| | - Frederique Verly
- Department of Pediatrics, Program for Patient Safety and Quality, Boston Children's Hospital, Boston, MA, USA
| | - Charles Samson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter Margolis
- Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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30
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Chew CC, Hss AS, Chan HK, Hassali MA. Medication Safety at Home: A Qualitative Study on Caregivers of Chronically Ill Children in Malaysia. Hosp Pharm 2019; 55:405-411. [PMID: 33245714 DOI: 10.1177/0018578719851719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Medication errors are more likely to occur in chronically ill children, who are highly dependent on caregivers for medication administration. This study aimed to explore the issues related to medication safety among pediatric outpatients in Malaysia from the caregivers' perspective. Methods: This was a qualitative study conducted between May and June 2018 at a pediatric clinic of a regional referral hospital. Caregivers of children who (1) were under 6 years of age and (2) had hypothyroidism, epilepsy, thalassemia, asthma, or other chronic diseases were recruited via purposive sampling. Each selected disease was represented by at least 3 caregivers, who were identified from the medical records of their children. Face-to-face interviews were conducted with each of them, facilitated by a semi-structured interview guide. All the interviews were audio-recorded, transcribed verbatim, and analyzed using the thematic analysis approach. Results: A total of 15 mothers with a median age of 34 years were interviewed. Three themes emerged from the interviews: (I) actual experiences with medication errors, (II) underlying risk factors for medication errors, and (III) recommendations to improve medication safety. Several cases of administration errors, including missed doses and self-decided dose adjustment, were detected. Furthermore, the caregivers were found to have inadequate understanding of the medications in general. Conclusions: While children were shown to be consistently exposed to medication errors at home in Malaysia, the recommendations of the caregivers, including the use of written instructions and a diary, could be effective strategies to improve the out-of-hospital medication safety in children.
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Affiliation(s)
- Chii-Chii Chew
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia.,Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Malaysia
| | - Amar-Singh Hss
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Malaysia.,Pediatric Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Malaysia
| | - Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health, Malaysia
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Feinstein JA, Hall M, Antoon JW, Thomson J, Flores JC, Goodman DM, Cohen E, Azuine R, Agrawal R, Houtrow AJ, DeCourcey DD, Kuo DZ, Coller R, Gaur DS, Berry JG. Chronic Medication Use in Children Insured by Medicaid: A Multistate Retrospective Cohort Study. Pediatrics 2019; 143:peds.2018-3397. [PMID: 30914443 PMCID: PMC6456893 DOI: 10.1542/peds.2018-3397] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known about the use of chronic medications (CMs) in children. We assessed the prevalence of CM use in children and the association of clinical characteristics and health care resource use with the number of CMs used. METHODS This is a retrospective study of children ages 1 to 18 years using Medicaid from 10 states in 2014 grouped by the annual number of CMs (0, 1, 2-4, 5-9, and ≥10 medications), which are defined as a dispensed ≥30-day prescription with ≥2 dispensed refills. Trends in clinical characteristics and health care use by number of CMs were evaluated with the Cochran-Armitage trend test. RESULTS Of 4 594 061 subjects, 18.8% used CMs. CM use was 44.4% in children with a complex chronic condition. Across all children, the most common CM therapeutic class was neurologic (28.9%). Among CM users, 48.8% used multiple CMs (40.3% used 2-4, 7.0% used 5-9, and 0.5% used ≥10). The diversity of medications increased with increasing number of CMs: for 1 CM, amphetamine stimulants were most common (29.0%), and for ≥10 CMs, antiepileptics were most common (7.1%). Of $2.3 billion total pharmacy spending, 59.3% was attributable to children dispensed multiple CMs. Increased CM use (0 to ≥10 medications) was associated with increased emergency department use (32.1% to 56.2%) and hospitalization (2.3% to 36.7%). CONCLUSIONS Nearly 1 in 5 children with Medicaid used CMs. Use of multiple CMs was common and correlated with increased health care use. Understanding CM use in children should be fundamentally important to health care systems when strategizing how to provide safe, evidence-based, and cost-effective pharmaceutical care to children.
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Affiliation(s)
- James A. Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - James W. Antoon
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Joanna Thomson
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Juan Carlos Flores
- Division of Pediatrics, Pontificia Universidad Catolica de Chile, Hospital Sotero del Rio, Santiago, Chile
| | - Denise M. Goodman
- Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eyal Cohen
- Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Romuladus Azuine
- Maternal and Child Health Bureau, US Department of Health and Human Services, Rockville, Maryland
| | - Rishi Agrawal
- Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Amy J. Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Dennis Z. Kuo
- Department of Pediatrics, University at Buffalo, Buffalo, New York
| | - Ryan Coller
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin; and
| | | | - Jay G. Berry
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
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Mueller BU, Neuspiel DR, Fisher ERS, Franklin W, Adirim T, Bundy DG, Ferguson LE, Gleeson SP, Leu M, Quinonez RA, Rinke ML, Shiffman RN, Saarel EV, Tieder JS, Yin HS, Phillips SC, Quinonez R, Brown JM, Walsh KM, Jewell J, Ernst K, Hill VL, Lam V, Vinocur C, Rauch D, Hsu B. Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care. Pediatrics 2019; 143:peds.2018-3649. [PMID: 30670581 DOI: 10.1542/peds.2018-3649] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its report "To Err Is Human: Building a Safer Health System" in 1999. Patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to reveal a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification and diagnostic error. Pediatric health care providers in all practice environments benefit from having a working knowledge of patient safety language. Pediatric providers should serve as advocates for best practices and policies with the goal of attending to risks that are unique to children, identifying and supporting a culture of safety, and leading efforts to eliminate avoidable harm in any setting in which medical care is rendered to children. In this Policy Statement, we provide an update to the 2011 Policy Statement "Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care."
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Affiliation(s)
- Brigitta U. Mueller
- Johns Hopkins All Children’s Hospital, St Petersburg, Florida
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Erin R. Stucky Fisher
- Department of Pediatrics, University of California San Diego and Rady Children’s Hospital San Diego, San Diego, California
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Miller R, Tumin D, Hayes D, Uffman JC, Raman VT, Tobias JD. Unmet Need for Care Coordination Among Children with Special Health Care Needs. Popul Health Manag 2018; 22:255-261. [PMID: 30272532 DOI: 10.1089/pop.2018.0094] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Socioeconomic disparities in access to care coordination have been noted among children with special health care needs (CSHCN). Following recent policy developments and technological innovation, care coordination has become more widespread, possibly leading to reduced disparity in care coordination access. This study investigates whether child and household characteristics remain associated with unmet need for care coordination among CSHCN. CSHCN (aged <18 years) requiring ≥2 types of health services in the past year were identified in the 2016 National Survey of Children's Health (NSCH). Care coordination was defined as help with arranging the child's care among different doctors or services. Children were classified as not needing care coordination, receiving sufficient care coordination (met need), or needing but not receiving care coordination (unmet need). Weighted multinomial logistic regression examined the association of child characteristics with this outcome. The analysis included 5622 children with no need for care coordination, 1466 with a met need, and 980 with unmet needs. Children with mental health conditions were more likely to have unmet rather than met needs for care coordination (odds ratio = 4.1; 95% confidence interval: 2.7, 6.1; P < 0.001). After multivariable adjustment, race/ethnicity, income, family structure, insurance coverage, place of birth, and use of English in the home were not associated with having unmet rather than met needs for care coordination. Among CSHCN, the latest data from NSCH reveal no evidence of previously described socioeconomic disparities in access to care coordination. Nevertheless, unmet needs for care coordination remain prevalent, especially among children with mental health conditions.
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Affiliation(s)
- Rebecca Miller
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Dmitry Tumin
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,2 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Don Hayes
- 3 Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.,4 Department of Pulmonary and Critical Care Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joshua C Uffman
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,5 Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Vidya T Raman
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,5 Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph D Tobias
- 1 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,5 Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio
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34
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Rees P, Wimberg J, Walsh KE. Patient and Family Partnership for Safer Health Care. Pediatrics 2018; 142:peds.2017-2847. [PMID: 30087198 DOI: 10.1542/peds.2017-2847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Philippa Rees
- University College London Great Ormond Street Institute of Child Health, University College London, London, United Kingdom;
| | - Janet Wimberg
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kathleen E Walsh
- James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
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35
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Schumacher PM, Kaune A, Merkenschlager A, Bernhard MK, Kiess W, Neininger MP, Bertsche A, Bertsche T. Optimizing parents' performance in anticonvulsant rescue medication administration. Epilepsy Behav 2018; 84:37-43. [PMID: 29747033 DOI: 10.1016/j.yebeh.2018.02.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Parents of children with epilepsy are at risk of committing high-risk handling errors with a high potential to harm the patient when administering anticonvulsant rescue medication. We developed a training concept addressing identified high-risk handling errors and investigated its effects on parents' skills. STUDY DESIGN In a controlled prospective intervention study, parents of children with epilepsy were asked to demonstrate their administration of rescue medication by using dummy dolls. A clinical pharmacist monitored rectal or buccal administration and addressed errors in the intervention group with training and information sheets. Three to 6weeks later, intervention's sustainability was assessed at a home visit. RESULTS One hundred sixty-one parents completed full study assessment: 92 in the intervention group and 69 in the control group. The number of processes with at least one handling error was reduced from 96.4% to 56.7% in rectal tube administration and from 66.7% to 13.5% in buccal administration (both p<0.001). CONCLUSION A one-time intervention for parents significantly and sustainably reduced high-risk handling errors. Dummy dolls and information sheet were adequate for an effective and feasible training to support the correct administration of anticonvulsant rescue medication.
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Affiliation(s)
- Pia Madeleine Schumacher
- Drug Safety Center and Dept. of Clinical Pharmacy, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany.
| | - Almuth Kaune
- Drug Safety Center and Dept. of Clinical Pharmacy, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany.
| | - Andreas Merkenschlager
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany.
| | - Matthias Karl Bernhard
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany.
| | - Wieland Kiess
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany.
| | - Martina Patrizia Neininger
- Drug Safety Center and Dept. of Clinical Pharmacy, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany.
| | - Astrid Bertsche
- University Hospital for Children and Adolescents, Centre of Pediatric Research, Liebigstraße 20a, 04103 Leipzig, Germany.
| | - Thilo Bertsche
- Drug Safety Center and Dept. of Clinical Pharmacy, Leipzig University, Brüderstraße 32, 04103 Leipzig, Germany.
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Wilson Smith MG, Sachse K, Perry MT. Road to Home Program: A Performance Improvement Initiative to Increase Family and Nurse Satisfaction With the Discharge Education Process for Newly Diagnosed Pediatric Oncology Patients. J Pediatr Oncol Nurs 2018; 35:368-374. [DOI: 10.1177/1043454218767872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Families of children, adolescents, and young adults with a new oncology diagnosis must absorb knowledge and skills needed to care for their child at home during a period of emergent hospitalizations and intense medical interventions. Effective nurse-led teaching and discharge planning begun at diagnosis can prepare families to safely care for their child following discharge, and be a source of satisfaction. The objective of this performance improvement initiative was to increase family and nurse satisfaction with new diagnosis education and discharge. Using standard performance improvement techniques, family and nursing stakeholder satisfaction with current processes was assessed. Working from established best practice and literature review; The Road to Home was designed and implemented. This novel, comprehensive program includes a visual, interactive display of required education based on the Children’s Oncology Group Family Handbook© and hospital specific discharge materials; standardized teaching, tools and documentation for nursing; and caregiver discharge tool kits. Stakeholder input guided improvement strategies throughout the phases of implementation. Sustained increases in family and nurse satisfaction resulted from each phase. The Road to Home program is established for all families of newly diagnosed oncology patients and is meeting goals of increased family and nurse satisfaction with discharge education.
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W Guite J, Sherry DD, Jarvis EW, O Lewen M, Khan S, Wickham Kraemer F. Medication use among pediatric patients with chronic musculoskeletal pain syndromes at initial pain clinic evaluation. Pain Manag 2018; 8:15-25. [PMID: 29199542 PMCID: PMC5753621 DOI: 10.2217/pmt-2017-0034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/22/2017] [Indexed: 11/21/2022] Open
Abstract
AIM To characterize medication use by adolescents with chronic musculoskeletal pain syndromes before an initial multidisciplinary clinic visit. PATIENTS & METHODS A cross-sectional sample of 120 adolescents and parents reported on standardized assessment measures, with medication use data extracted from the medical chart and categorized. RESULTS On average, 3.2 medications were reported; 70% used more than one pain-specific medication including opioids (17%), nonopioids (31%), psychotropics/neuropathics (45%) and other medications (13%). Adolescents with complex regional pain syndrome consistently reported greatest use of opioid, psychotropic/neuropathic and other pain medications. A regression model explained 17% of the variance in pain medication use. Nonpain medication use and disability contributed unique variance - pain duration and intensity did not. CONCLUSION Greater attention to factors contributing to prescriptive practices, medication use and long-term outcomes is warranted.
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Affiliation(s)
- Jessica W Guite
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 06032, USA
- Center for Behavioral Health, Connecticut Children's Medical Center, Hartford, CT 06106, USA
| | - David D Sherry
- Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Esther W Jarvis
- Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Margaret O Lewen
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sarosh Khan
- Center for Behavioral Health, Connecticut Children's Medical Center, Hartford, CT 06106, USA
| | - Francis Wickham Kraemer
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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Abstract
Background: High-risk infants transitioning from the neonatal intensive care unit (NICU) to home represent a vulnerable population, given their complex care requirements. Little is known about errors during this period. Purpose: Identify and describe homecare and healthcare utilization errors in high-risk infants following NICU discharge. Methods: This was a prospective observational cohort study of homecare (feeding, medication, and equipment) and healthcare utilization (appointment) errors in infants discharged from a regional NICU between 2011 and 2015. Chi-square test and Wilcoxon rank-sum test were used to compare infant and maternal demographics between infants with and without errors. Results: A total of 363 errors were identified in 241 infants during 635 home visits. The median number of visits was 2. No significance was found between infant and maternal demographics in those with or without errors. Implications of Practice: High-risk infants have complex care needs and can benefit from regular follow-up services. Home visits provide an opportunity to identify, intervene, and resolve homecare and healthcare utilization errors. Implications of Research: Further research is needed to evaluate the prevalence and cause of homecare errors in high-risk infants and how healthcare resources and infant health outcomes are affected by those errors. Preventive measures and mitigating interventions that best address homecare errors require further development and subsequent description.
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Solanki R, Mondal N, Mahalakshmy T, Bhat V. Medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit. Arch Dis Child 2017; 102:651-654. [PMID: 28468867 DOI: 10.1136/archdischild-2016-311877] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/26/2017] [Accepted: 03/18/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the frequency of medication errors by caregivers at home in neonates discharged from the neonatal intensive care unit and to identify the associated risk factors. METHODS A descriptive, cross-sectional study was conducted in the High Risk Newborn Follow-up Clinic of our institute, on a sample of 166 children, <3 months old. The medications prescribed (syrup preparations of vitamin D, multivitamins, calcium, iron and levetiracetam, tablet L-thyroxine and ursodeoxycholic acid and human milk fortifier powder) were noted from the discharge summary. The caregiver who usually administered the medicines to the child at home was asked the names of the medications, frequency of their administration and to show in a measuring cup/syringe/dropper the dose of the medication. The names, doses and frequency of the drugs as reported were matched against those actually prescribed in the discharge summary. Various risk factors probably associated with medication errors, were noted. RESULTS The frequency of medication errors by caregivers in infants discharged from the neonatal intensive care unit was 66.3%. Dose administration error, that is, measurement of a dose different from what was prescribed was the most common error (54%). A prescription containing more than three drugs was found to have statistically significant association (OR 4.19, CI 1.59 to 11.07, p=0.00). CONCLUSION Medication errors by caregivers in infants less than 3 months of age are very common, dose administration error being the most common type. A prescription of more than three drugs increases the odds of an error.
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Affiliation(s)
- Ritanshu Solanki
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Nivedita Mondal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Thulasingam Mahalakshmy
- Department of P&SM, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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40
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Nursing-led Home Visits Post-hospitalization for Children with Medical Complexity. J Pediatr Nurs 2017; 34:10-16. [PMID: 28342694 DOI: 10.1016/j.pedn.2017.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE Hospital discharge for children with medical complexity (CMC) can be challenging for families. Home visits could potentially benefit CMC and their families after leaving the hospital. We assessed the utility of post-discharge home visits to identify and address health problems for recently hospitalized CMC. DESIGN AND METHODS A prospective study of 36 CMC admitted to a children's hospital from 4/15/2015 to 4/14/2016 identified with a possible high risk of hospital readmission and offered a post-discharge home visit within 72h of discharge. The visit was staffed by a hospital nurse familiar with the child's admission. The home visit goals were to reinforce education of the discharge plan, assess the child's home environment, and identify and address any problems or issues that emerged post-discharge. RESULTS The children's median age was 6years [interquartile range (IQR) 2-18]. The median distance from hospital to their home was 38miles (IQR 8-78). All (n=36) children had multiple chronic conditions; 89% (n=32) were assisted with medical technology. The nurse identified and helped with a post-discharge problem during every (n=36) visit. Of the 147 problems identified, 26.5% (n=39) pertained to social/family issues (e.g., financial instability), 23.8% (n=35) medications (e.g., wrong dose), 20.4% (n=30) durable medical equipment (e.g., insufficient supply or faulty function), 20.4% (n=30) child's home environment (e.g., unsafe sleeping arrangement), and 8.8% (n=13) child's health (e.g., unresolved health problem). CONCLUSIONS Home visits helped identify and address post-discharge issues that occurred for discharged CMC. PRACTICAL IMPLICATIONS Hospitals should consider home visits when optimizing discharge care for CMC.
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Rees P, Edwards A, Powell C, Hibbert P, Williams H, Makeham M, Carter B, Luff D, Parry G, Avery A, Sheikh A, Donaldson L, Carson-Stevens A. Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. PLoS Med 2017; 14:e1002217. [PMID: 28095408 PMCID: PMC5240916 DOI: 10.1371/journal.pmed.1002217] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting. METHODS AND FINDINGS We undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales' National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions. Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods. CONCLUSIONS This study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality.
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Affiliation(s)
- Philippa Rees
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
- Institute of Child Health, University College London, London, United Kingdom
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Colin Powell
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Peter Hibbert
- Australian Institute for Healthcare Innovation, Macquarie University, Macquarie, Australia
| | - Huw Williams
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Meredith Makeham
- Australian Institute for Healthcare Innovation, Macquarie University, Macquarie, Australia
| | - Ben Carter
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Donna Luff
- Institute for Professionalism and Ethical Practice, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesia, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Gareth Parry
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
- Institute for Healthcare Improvement, Cambridge, Massachusetts, United States of America
| | - Anthony Avery
- Division of General Practice, University of Nottingham, Nottingham, United Kingdom
| | - Aziz Sheikh
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Liam Donaldson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew Carson-Stevens
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
- Australian Institute for Healthcare Innovation, Macquarie University, Macquarie, Australia
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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Parand A, Garfield S, Vincent C, Franklin BD. Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review. PLoS One 2016; 11:e0167204. [PMID: 27907072 PMCID: PMC5132322 DOI: 10.1371/journal.pone.0167204] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 11/10/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose Medications are mostly taken in patients’ own homes, increasingly administered by carers, yet studies of medication safety have been largely conducted in the hospital setting. We aimed to review studies of how carers cause and/or prevent medication administration errors (MAEs) within the patient’s home; to identify types, prevalence and causes of these MAEs and any interventions to prevent them. Methods A narrative systematic review of literature published between 1 Jan 1946 and 23 Sep 2013 was carried out across the databases EMBASE, MEDLINE, PSYCHINFO, COCHRANE and CINAHL. Empirical studies were included where carers were responsible for preventing/causing MAEs in the home and standardised tools used for data extraction and quality assessment. Results Thirty-six papers met the criteria for narrative review, 33 of which included parents caring for children, two predominantly comprised adult children and spouses caring for older parents/partners, and one focused on paid carers mostly looking after older adults. The carer administration error rate ranged from 1.9 to 33% of medications administered and from 12 to 92.7% of carers administering medication. These included dosage errors, omitted administration, wrong medication and wrong time or route of administration. Contributory factors included individual carer factors (e.g. carer age), environmental factors (e.g. storage), medication factors (e.g. number of medicines), prescription communication factors (e.g. comprehensibility of instructions), psychosocial factors (e.g. carer-to-carer communication), and care-recipient factors (e.g. recipient age). The few interventions effective in preventing MAEs involved carer training and tailored equipment. Conclusion This review shows that home medication administration errors made by carers are a potentially serious patient safety issue. Carers made similar errors to those made by professionals in other contexts and a wide variety of contributory factors were identified. The home care setting should be a priority for the development of patient safety interventions.
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Affiliation(s)
- Anam Parand
- Department of Social Psychology, The London School of Economics, London, United Kingdom / The National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, United Kingdom
- * E-mail:
| | - Sara Garfield
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust / Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust / Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
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Boztepe H, Özdemir H, Karababa Ç, Yıldız Ö. Administration of oral medication by parents at home. J Clin Nurs 2016; 25:3345-3353. [PMID: 27346536 DOI: 10.1111/jocn.13460] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVE The objective of this study was to determine parents' experiences and problems with administering medication to their children at home. BACKGROUND Parents' experiences and access to information for the treatment of their children's illnesses at home is necessary for their children's safety. DESIGN A descriptive cross-sectional study. METHODS Four hundred parents from children's hospital outpatient clinics were included. A questionnaire was used to determine parents' experiences and problems with administering medication to their children at home. Descriptive statistical analyses were performed using the spss software package (version 22.00). RESULTS Antipyretics (59%) and antibiotics (25%) were the most commonly used medicines by parents without prescription. Nearly half of the parents stated that they gave liquid medicine with a household spoon. It was found that 54% of the parents whose children refused to take tablets or liquid medicine mixed these medications into foods. Treatment was delayed in 20·7% of the children who refused to take tablets and in 29·1% of the children who refused to take liquid medicine. As a result of the project, a form and device were developed as a solution to the problems experienced by parents while administering oral medication in the home environment. CONCLUSION The results of the study showed that a significant percentage of the parents did not use the correct equipment to administer medications, used non-prescription medicines, did not administer medications at correct intervals and mixed medication into foods. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals, especially nurses, should continually evaluate medication administration by parents at home and the readmission rate in the emergency department to further improve children's health.
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Affiliation(s)
- Handan Boztepe
- Faculty of Nursing, Department of Pediatric Nursing, Hacettepe University, Ankara, Turkey.
| | - Handan Özdemir
- İhsan Doğramacı Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Çiğdem Karababa
- İhsan Doğramacı Children's Hospital, Hacettepe University, Ankara, Turkey
| | - Özlem Yıldız
- İhsan Doğramacı Children's Hospital, Hacettepe University, Ankara, Turkey
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Berthe-Aucejo A, Girard D, Lorrot M, Bellettre X, Faye A, Mercier JC, Brion F, Bourdon O, Prot-Labarthe S. Evaluation of frequency of paediatric oral liquid medication dosing errors by caregivers: amoxicillin and josamycin. Arch Dis Child 2016; 101:359-64. [PMID: 26729746 DOI: 10.1136/archdischild-2015-309426] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/01/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study reconstitution and preparation dosing errors of liquid oral medications given by caregivers to children. METHODS A prospective observational study was carried out in the departments of general paediatrics and emergency paediatrics at the Robert-Debré Children's University Hospital. An interview with caregivers involved (1) practical reconstitution and preparation of an oral liquid medication from a prescription drawn at random (amoxicillin (Clamoxyl, dosing spoon) or josamycin (Josacine, dose-weight pipette)) and (2) a questionnaire about their use. RESULTS One hundred caregivers were included. Clamoxyl and Josacine were incorrectly reconstituted in 46% (23/50) and 56% (28/50) of cases, respectively, with a risk of underdosing of Clamoxyl (16/23) and overdosing of Josacine (23/28). Dose preparation with the dosing spoon was incorrect in 56% of cases, and in 10% of cases with the dose-weight pipette. Female sex, native French speaker, and age were significantly associated with correct reconstitution. Male sex and medication were significantly associated with correct preparation. CONCLUSIONS This study highlights the high incidence of errors made by caregivers in reconstituting and preparing doses of these liquid oral medicines, which are associated with considerable risks of over- and underdosing. Factors associated with these errors have been identified which could help health professionals to optimise their strategy for educating families about the use of liquid oral medications and the need to check that they understand these instructions.
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Affiliation(s)
| | - D Girard
- Unité d'Epidémiologie Clinique, AP-HP Hôpital Robert-Debré, Paris, France Pediatric Pulmonology Research Group, University Children's Hospital, Basel, Switzerland
| | - M Lorrot
- Service de pédiatrie Générale, AP-HP Hôpital Robert-Debré, Paris, France Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - X Bellettre
- Service d'Accueil des Urgences Pédiatriques, AP-HP Hôpital Robert-Debré, Paris, France
| | - A Faye
- Service de pédiatrie Générale, AP-HP Hôpital Robert-Debré, Paris, France Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - J C Mercier
- Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France Service d'Accueil des Urgences Pédiatriques, AP-HP Hôpital Robert-Debré, Paris, France
| | - F Brion
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France Pharmacie clinique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire Educations et Pratiques de Santé, EA 3412, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - O Bourdon
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France Pharmacie clinique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire Educations et Pratiques de Santé, EA 3412, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - S Prot-Labarthe
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France INSERM, U1123, ECEVE, Paris, France
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Lajoinie A, Henin E, Kassai B, Terry D. Solid oral forms availability in children: a cost saving investigation. Br J Clin Pharmacol 2015; 78:1080-9. [PMID: 24965935 DOI: 10.1111/bcp.12442] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/07/2014] [Indexed: 11/29/2022] Open
Abstract
AIM To assess the suitability and potential cost savings, from both the hospital and community perspective, of prescribed oral liquid medicine substitution with acceptable solid forms for children over 2 years. METHOD Oral liquid medicines dispensed from a paediatric hospital (UK) in 1 week were assessed by screening for existence of the solid form alternative and evaluating the acceptability of the available solid form, firstly related to the prescribed dose and secondly to acceptable size depending on the child's age. Costs were calculated based on providing treatment for 28 days or prescribed duration for short term treatments. RESULTS Over 90% (440/476) of liquid formulations were available as a marketed solid form. Considering dosage acceptability (maximum of 10% deviation from prescribed dosage or 0% for narrow therapeutic range drugs, maximum tablet divisions into quarters) 80% of liquids could be substituted with a solid form. The main limitation for liquid substitution would be solid form size. However, two-thirds of prescribed liquids could have been substituted with a suitable solid form for dosage and size, with estimated savings being of £5K and £8K in 1 week, respectively based on hospital and community costs, corresponding to a projected annual saving of £238K and £410K (single institution). CONCLUSION Whilst not all children over 2 years will be able to swallow tablets, drug cost savings if oral liquid formulations were substituted with suitable solid dosage forms would be considerable. Given the numerous advantages of solid forms compared with liquids, this study may provide a theoretical basis for investing in supporting children to swallow tablets/capsules.
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Affiliation(s)
- Audrey Lajoinie
- EPICIME-CIC 1407 Inserm, Service de Pharmacologie Clinique, Hospices Civils de Lyon Lyon, F-69677, Bron, France; Université Lyon 1, UMR 5558 CNRS, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France
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Basco WT, Ebeling M, Garner SS, Hulsey TC, Simpson K. Opioid Prescribing and Potential Overdose Errors Among Children 0 to 36 Months Old. Clin Pediatr (Phila) 2015; 54:738-44. [PMID: 25971461 PMCID: PMC4474749 DOI: 10.1177/0009922815586050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To estimate the frequency of potential overdoses among outpatient opioid-containing prescriptions. METHOD Using 11 years of outpatient Medicaid prescription data, we compared opioid dose dispensed (observed) versus expected dose to estimate overdose error frequencies. A potential overdose was defined as any preparation dispensed that was >110% of expected based on imputed, 97th percentile weights. RESULTS There were 59 536 study drug prescriptions to children 0 to 36 months old. Overall, 2.7% of the prescriptions contained potential overdose quantities, and the average excess amount dispensed was 48% above expected. Younger ages were associated with higher frequencies of potential overdose. For example, 8.9% of opioid prescriptions among infants 0 to 2 months contained potential overdose quantities, compared with 5.7% among infants 3 to 5 months old, 3.6% among infants 6 to 11 months old, and 2.3% among children >12 months (P < .0001). CONCLUSIONS Opioid prescriptions for infants and children routinely contained potential overdose quantities.
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Affiliation(s)
| | - Myla Ebeling
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Kit Simpson
- Medical University of South Carolina, Charleston, SC, USA
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Mira JJ, Lorenzo S, Guilabert M, Navarro I, Pérez-Jover V. A systematic review of patient medication error on self-administering medication at home. Expert Opin Drug Saf 2015; 14:815-38. [PMID: 25774444 DOI: 10.1517/14740338.2015.1026326] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Medication errors have been analyzed as a health professionals' responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients themselves (or their caregivers) make mistakes in the administration of the medication. The epidemiology of patient medication errors (PEs) has been scarcely reviewed in spite of its impact on people, on therapeutic effectiveness and on incremental cost for the health systems. AREAS COVERED This study reviews and describes the methodological approaches and results of published studies on the frequency, causes and consequences of medication errors committed by patients at home. A review of research articles published between 1990 and 2014 was carried out using MEDLINE, Web-of-Knowledge, Scopus, Tripdatabase and Index Medicus. EXPERT OPINION The frequency of PE was situated between 19 and 59%. The elderly and the preschooler population constituted a higher number of mistakes than others. The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs. The majority of these mistakes have no negative consequences. Health literacy, information and communication and complexity of use of dispensing devices were identified as causes of PEs. Apps and other new technologies offer several opportunities for improving drug safety.
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Affiliation(s)
- José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant , Alicante , Spain
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Auger KA, Simon TD, Cooperberg D, Gay J, Kuo DZ, Saysana M, Stille CJ, Fisher ES, Wallace S, Berry J, Coghlin D, Jhaveri V, Kairys S, Logsdon T, Shaikh U, Srivastava R, Starmer AJ, Wilkins V, Shen MW. Summary of STARNet: Seamless Transitions and (Re)admissions Network. Pediatrics 2015; 135:164-75. [PMID: 25489017 PMCID: PMC4279069 DOI: 10.1542/peds.2014-1887] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The Seamless Transitions and (Re)admissions Network (STARNet) met in December 2012 to synthesize ongoing hospital-to-home transition work, discuss goals, and develop a plan to centralize transition information in the future. STARNet participants consisted of experts in the field of pediatric hospital medicine quality improvement and research, and included physicians and key stakeholders from hospital groups, private payers, as well as representatives from current transition collaboratives. In this report, we (1) review the current knowledge regarding hospital-to-home transitions; (2) outline the challenges of measuring and reducing readmissions; and (3) highlight research gaps and list potential measures for transition quality. STARNet met with the support of the American Academy of Pediatrics' Quality Improvement Innovation Networks and the Section on Hospital Medicine.
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Affiliation(s)
- Katherine A. Auger
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tamara D. Simon
- Division of Hospital Medicine, Department of Pediatrics, University of Washington and Seattle Children’s Hospital, Seattle, Washington
| | - David Cooperberg
- St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - James Gay
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dennis Z. Kuo
- Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Michele Saysana
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Christopher J. Stille
- General Academic Pediatrics, University of Colorado School of Medicine/Children’s Hospital Colorado, Aurora, Colorado
| | - Erin Stucky Fisher
- University of California San Diego School of Medicine, San Diego, California
| | - Sowdhamini Wallace
- Section of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Jay Berry
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Daniel Coghlin
- Hasbro Children’s Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Vishu Jhaveri
- Blue Cross Blue Shield of Arizona representing Blue Cross Blue Shield Association, Phoenix, Arizona
| | - Steven Kairys
- Jersey Shore Medical Center, Neptune Township, New Jersey
| | - Tina Logsdon
- Children’s Hospital Association, Overland Park, Kansas
| | - Ulfat Shaikh
- University of California Davis Health System, Sacramento, California
| | - Rajendu Srivastava
- Division of Inpatient Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah; and
| | - Amy J. Starmer
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Victoria Wilkins
- Division of Inpatient Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah; and
| | - Mark W. Shen
- Dell Medical School, University of Texas Austin, Austin, Texas
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Walsh KE, Cutrona SL, Kavanagh PL, Crosby LE, Malone C, Lobner K, Bundy DG. Medication adherence among pediatric patients with sickle cell disease: a systematic review. Pediatrics 2014; 134:1175-83. [PMID: 25404717 PMCID: PMC4243064 DOI: 10.1542/peds.2014-0177] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Describe rates of adherence for sickle cell disease (SCD) medications, identify patient and medication characteristics associated with nonadherence, and determine the effect of nonadherence and moderate adherence (defined as taking 60%-80% of doses) on clinical outcomes. METHODS In February 2012 we systematically searched 6 databases for peer-reviewed articles published after 1940. We identified articles evaluating medication adherence among patients <25 years old with SCD. Two authors reviewed each article to determine whether it should be included. Two authors extracted data, including medication studied, adherence measures used, rates of adherence, and barriers to adherence. RESULTS Of 24 articles in the final review, 23 focused on 1 medication type: antibiotic prophylaxis (13 articles), iron chelation (5 articles), or hydroxyurea (5 articles). Adherence rates ranged from 16% to 89%; most reported moderate adherence. Medication factors contributed to adherence. For example, prophylactic antibiotic adherence was better with intramuscular than oral administration. Barriers included fear of side effects, incorrect dosing, and forgetting. Nonadherence was associated with more vaso-occlusive crises and hospitalizations. The limited data available on moderate adherence to iron chelation and hydroxyurea indicates some clinical benefit. CONCLUSIONS Moderate adherence is typical among pediatric patients with SCD. Multicomponent interventions are needed to optimally deliver life-changing medications to these children and should include routine monitoring of adherence, support to prevent mistakes, and education to improve understanding of medication risks and benefits.
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Affiliation(s)
- Kathleen E. Walsh
- Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio;,Departments of Pediatrics, and,Meyers Primary Care Institute, Worcester, Massachusetts
| | - Sarah L. Cutrona
- Medicine, University of Massachusetts, Worcester, Massachusetts;,Meyers Primary Care Institute, Worcester, Massachusetts
| | | | - Lori E. Crosby
- Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Chris Malone
- Meyers Primary Care Institute, Worcester, Massachusetts
| | - Katie Lobner
- Welch Medical Library, Johns Hopkins Medical Center, Baltimore, Maryland; and
| | - David G. Bundy
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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Walsh KE, Biggins C, Blasko D, Christiansen SM, Fischer SH, Keuker C, Klugman R, Mazor KM. Home medication support for childhood cancer: family-centered design and testing. J Oncol Pract 2014; 10:373-6. [PMID: 25336081 DOI: 10.1200/jop.2014.001482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Errors in the use of medications at home by children with cancer are common, and interventions to support correct use are needed. We sought to (1) engage stakeholders in the design and development of an intervention to prevent errors in home medication use, and (2) evaluate the acceptability and usefulness of the intervention. METHODS We convened a multidisciplinary team of parents, clinicians, technology experts, and researchers to develop an intervention using a two-step user-centered design process. First, parents and oncologists provided input on the design. Second, a parent panel and two oncology nurses refined draft materials. In a feasibility study, we used questionnaires to assess usefulness and acceptability. Medication error rates were assessed via monthly telephone interviews with parents. RESULTS We successfully partnered with parents, clinicians, and IT experts to develop Home Medication Support (HoMeS), a family-centered Web-based intervention. HoMeS includes a medication calendar with decision support, a communication tool, adverse effect information, a metric conversion chart, and other information. The 15 families in the feasibility study gave HoMeS high ratings for acceptability and usefulness. Half recorded information on the calendar to indicate to other caregivers that doses were given; 34% brought it to the clinic to communicate with their clinician about home medication use. There was no change in the rate of medication errors in this feasibility study. CONCLUSION We created and tested a stakeholder-designed, Web-based intervention to support home chemotherapy use, which parents rated highly. This tool may prevent serious medication errors in a larger study.
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Affiliation(s)
- Kathleen E Walsh
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Colleen Biggins
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Deb Blasko
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Steven M Christiansen
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Shira H Fischer
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Christopher Keuker
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Robert Klugman
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
| | - Kathleen M Mazor
- Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA; and InterVision Media, Eugene, OR
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